Prevalence of anxiety, depression, and stress, as well as their psychosocial correlates, among medical students during the COVID-19 pandemic

Document Type : Research Paper


1 Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

4 Department of Occupational Medicine, Division of Sleep Medicine, Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran


Introduction: The present study aimed to investigate the frequency of anxiety, depression, and stress, as well as their psychosocial correlates, in medical students during the COVID-19 pandemic.
Materials and Methods: This cross-sectional study was conducted on 347 medical students at Mashhad University of Medical Sciences, Mashhad, during the academic year 2020-2021. Data were collected using a structured online questionnaire. Depression, anxiety, and stress scale (DASS-21) was used to measure students' depression, anxiety, and stress levels.
Results: The results of the DASS test showed that 59.7%, 55.5%, and 57.4% of medical students experienced degrees of depression, anxiety, and stress, respectively. The frequency of depression was higher in medical students who did not have children (P=0.006), were less satisfied with their field of study (P<0.005), had substance abuse (P=0.01), and had history of infection with COVID-19 (P=0.02). The frequency of anxiety was higher in medical students who were less satisfied with their field of study (P=0.001), and had substance abuse (P=0.01). The frequency of stress was higher in medical students who were less satisfied with their field of study (P<0.005), had substance abuse (P=0.01), and did not receive COVID-19 vaccine (P=0.02).
Conclusion: More than 50% of the medical students reported some degree of depression, anxiety, and stress during the COVID-19 pandemic. The level of satisfaction with the academic field and substance abuse were related to all three subscales of depression, anxiety, and stress in medical students. The stress level was lower in students who received the COVID-19 vaccine.


Main Subjects

  1. Irawan AW, Dwisona D, Lestari M. Psychological impacts of students on online learning during the pandemic COVID-19. KONSELI: Jurnal Bimbingan dan Konseling (E-Journal). 2020;7(1):53-60.
  2. Froessl LJ, Abdeen Y. The silent pandemic: The psychological burden on frontline healthcare workers during COVID-19. Psychiatry Journal. 2021;2021.
  3. Usher K, Durkin J, Bhullar N. The COVID‐19 pandemic and mental health impacts. International journal of mental health nursing. 2020;29(3):315.
  4. Mak IWC, Chu CM, Pan PC, Yiu MGC, Chan VL. Long-term psychiatric morbidities among SARS survivors. General hospital psychiatry. 2009;31(4):318-26.
  5. Bai Y, Lin C-C, Lin C-Y, Chen J-Y, Chue C-M, Chou P. Survey of stress reactions among health care workers involved with the SARS outbreak. Psychiatric services. 2004;55(9):1055-7.
  6. Liu X, Kakade M, Fuller CJ, Fan B, Fang Y, Kong J, et al. Depression after exposure to stressful events: lessons learned from the severe acute respiratory syndrome epidemic. Comprehensive psychiatry. 2012;53(1):15-23.
  7. Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. International journal of environmental research and public health. 2020;17(5):1729.
  8. Elbay RY, Kurtulmuş A, Arpacıoğlu S, Karadere E. Depression, anxiety, stress levels of physicians and associated factors in Covid-19 pandemics. Psychiatry Research. 2020;290:113130.
  9. Halperin SJ, Henderson MN, Prenner S, Grauer JN. Prevalence of anxiety and depression among medical students during the Covid-19 pandemic: a cross-sectional study. Journal of medical education and curricular development. 2021;8:2382120521991150.
  10. Mousa OY, Dhamoon MS, Lander S, Dhamoon AS. The MD blues: under-recognized depression and anxiety in medical trainees. PloS one. 2016;11(6):e0156554.
  11. Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of psychological distress among US and Canadian medical students. Academic medicine. 2006;81(4):354-73.
  12. Hill MR, Goicochea S, Merlo LJ. In their own words: stressors facing medical students in the millennial generation. Medical education online. 2018;23(1):1530558.
  13. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA network open. 2020;3(3):e203976-e.
  14. Sahebi A, Asghari MJ, Salari RS. Validation of depression anxiety and stress scale (DASS-21) for an Iranian population. 2005.
  15. Johnson SU, Ebrahimi OV, Hoffart A. PTSD symptoms among health workers and public service providers during the COVID-19 outbreak. PloS one. 2020;15(10):e0241032.
  16. Wu P, Fang Y, Guan Z, Fan B, Kong J, Yao Z, et al. The psychological impact of the SARS epidemic on hospital employees in China: exposure, risk perception, and altruistic acceptance of risk. The Canadian Journal of Psychiatry. 2009;54(5):302-11.
  17. Abdulah DM, Musa DH. Insomnia and stress of physicians during COVID-19 outbreak. Sleep Medicine: X. 2020;2:100017.
  18. Lu Y-C, Shu B-C, Chang Y-Y. The mental health of hospital workers dealing with severe acute respiratory syndrome. Psychotherapy and psychosomatics. 2006;75(6):370-5.
  19. Maunder R, Hunter J, Vincent L, Bennett J, Peladeau N, Leszcz M, et al. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. Cmaj. 2003;168(10):1245-51.
  20. Lee AM, Wong JG, McAlonan GM, Cheung V, Cheung C, Sham PC, et al. Stress and psychological distress among SARS survivors 1 year after the outbreak. The Canadian Journal of Psychiatry. 2007;52(4):233-40.
  21. Kurt O, Deveci SE, Oguzoncul AF. Levels of anxiety and depression related to COVID-19 among physicians: An online cross-sectional study from Turkey. Annals of Clinical and Analytical Medicine. 2020;11(Suppl 3):S288-S93.
  22. Cebrián-Cuenca A, Mira JJ, Caride-Miana E, Fernández-Jiménez A, Orozco-Beltrán D. Sources of psychological distress among primary care physicians during the COVID-19 pandemic’s first wave in Spain: a cross-sectional study. Primary Health Care Research & Development. 2021;22.
  23. Naldi A, Vallelonga F, Di Liberto A, Cavallo R, Agnesone M, Gonella M, et al. COVID-19 pandemic-related anxiety, distress and burnout: Prevalence and associated factors in healthcare workers of North-West Italy. BJPsych open. 2021;7(1).
  24. Vala NH, Vachhani MV, Sorani AM. Study of anxiety, stress, and depression level among medical students during COVID-19 pandemic phase in Jamnagar city. National Journal of Physiology, Pharmacy and Pharmacology. 2020;10(12):1043-.
  25. Lasheras I, Gracia-García P, Lipnicki DM, Bueno-Notivol J, López-Antón R, De La Cámara C, et al. Prevalence of anxiety in medical students during the COVID-19 pandemic: a rapid systematic review with meta-analysis. International journal of environmental research and public health. 2020;17(18):6603.
  26. Nakhostin-Ansari A, Sherafati A, Aghajani F, Khonji MS, Aghajani R, Shahmansouri N. Depression and anxiety among Iranian medical students during COVID-19 pandemic. Iranian journal of psychiatry. 2020;15(3):228.
  27. Saraswathi I, Saikarthik J, Kumar KS, Srinivasan KM, Ardhanaari M, Gunapriya R. Impact of COVID-19 outbreak on the mental health status of undergraduate medical students in a COVID-19 treating medical college: a prospective longitudinal study. PeerJ. 2020;8:e10164.
  28. Yang Y, Lu L, Chen T, Ye S, Kelifa MO, Cao N, et al. Healthcare Worker's Mental Health and Their Associated Predictors During the Epidemic Peak of COVID-19. Psychol Res Behav Manag. 2021;14:221-31.
  29. Khalaf OO, Khalil MA, Abdelmaksoud R. Coping with depression and anxiety in Egyptian physicians during COVID-19 pandemic. Middle East Current Psychiatry. 2020;27(1):1-7.
  30. Bahadirli S, Sagaltici E. Burnout, job satisfaction, and psychological symptoms among emergency physicians during covid-19 outbreak: A cross-sectional study. Practitioner. 2021;83(25.1):20.8-9.9.
  31. Yilmaz A. Burnout, job satisfaction, and anxiety-depression among family physicians: A cross-sectional study. J Family Med Prim Care. 2018;7(5):952-6.
  32. Islam MN, Dasgupta DP, Sultana N, Yesmine F, Asaduzzaman M, Rabeya MR, et al. Factors associated with depression and determining dimensions of job satisfaction among physicians in Bangladesh. Heliyon. 2022;8(9):e10589.
  33. Oreskovich MR, Shanafelt T, Dyrbye LN, Tan L, Sotile W, Satele D, et al. The prevalence of substance use disorders in American physicians. The American journal on addictions. 2015;24(1):30-8.
  34. Sternat T, Katzman MA. Neurobiology of hedonic tone: the relationship between treatment-resistant depression, attention-deficit hyperactivity disorder, and substance abuse. Neuropsychiatric disease and treatment. 2016.
  35. Khanal P, Devkota N, Dahal M, Paudel K, Joshi D. Mental health impacts among health workers during COVID-19 in a low resource setting: a cross-sectional survey from Nepal. Globalization and health. 2020;16(1):1-12.
  36. Karakose T, Yirci R, Papadakis S. Examining the associations between COVID-19-related psychological distress, social media addiction, COVID-19-related burnout, and depression among school principals and teachers through Structural Equation Modeling. International journal of environmental research and public health. 2022;19(4):1951.
  37. Brown SD, Goske MJ, Johnson CM. Beyond Substance Abuse: Stress, Burnout, and Depression as Causes of Physician Impairment and Disruptive Behavior. Journal of the American College of Radiology. 2009;6(7):479-85.
  38. Cai CZ, Lin Y-L, Hu Z-J, Wong LP. Psychological and mental health impacts of COVID-19 pandemic on healthcare workers in China: A review. World Journal of Psychiatry. 2021;11(7):337.